National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 1249280

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1249280
VAERS Form:2
Age:
Sex:Male
Location:Florida
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Coronary artery occlusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210431438

Write-up: HEART ATTACK FROM BLOOD CLOT; This spontaneous report received from a patient via a company representative concerned a Not Hispanic or Latino and Asian male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced heart attack from blood clot and the patient died. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: This is an Asian male, unspecified age, who experienced a heart attack from a blood clot on an unspecified date after receiving the covid-19 vaccine ad26.cov2.s also on an unspecified date. No other details given. The information provided precludes a meaningful medical assessment. Additional information will be requested.; Reported Cause(s) of Death: DEATH


Changed on 5/7/2021

VAERS ID: 1249280 Before After
VAERS Form:2
Age:
Sex:Male
Location:Florida
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Coronary artery occlusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210431438

Write-up: HEART ATTACK FROM BLOOD CLOT; This spontaneous report received from a patient via a company representative concerned a Not Hispanic or Latino and Asian male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced heart attack from blood clot and the patient died. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: This is an Asian male, unspecified age, who experienced a heart attack from a blood clot on an unspecified date after receiving the covid-19 vaccine ad26.cov2.s also on an unspecified date. No other details given. The information provided precludes a meaningful medical assessment. Additional information will be requested.; Reported Cause(s) of Death: DEATH


Changed on 5/21/2021

VAERS ID: 1249280 Before After
VAERS Form:2
Age:
Sex:Male
Location:Florida
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Coronary artery occlusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210431438

Write-up: HEART ATTACK FROM BLOOD CLOT; This spontaneous report received from a patient via a company representative concerned a Not Hispanic or Latino and Asian male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced heart attack from blood clot and the patient died. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: This is an Asian male, unspecified age, who experienced a heart attack from a blood clot on an unspecified date after receiving the covid-19 vaccine ad26.cov2.s also on an unspecified date. No other details given. The information provided precludes a meaningful medical assessment. Additional information will be requested.; Reported Cause(s) of Death: DEATH

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1249280&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166